EIGHT frail elderly patients were left on chairs in University Hospital Limerick (UHL) due to chronic overcrowding on Tuesday night, according to a nursing union.
The Clare Champion can reveal that some vulnerable elderly patients were reportedly using a bed table to lean on due to the absence of proper facilities amid claims that the situation in the hospital is “unsafe”.
The INMO has estimated there are close on 100 nursing vacancies at the hospital as nurses struggle to cope with a surge in activity.
Concerns have been expressed about the impact of overcrowding at the hospital after the number of patients on trolleys increased from 62 on Monday to 69 on Tuesday, which was the highest level in the country.
This compared to 27 in Sligo University Hospital, which was the second most overcrowded hospital in the country.
The UL Hospitals’ Group has cancelled all elective activity and certain diagnostic procedures at UHL from Wednesday to Friday to de-escalate the site.
Outpatient clinics will continue to run. The group regrets the impact these cancellations will have on patients who have been self-isolating in advance of coming for their procedure.
Affected patients are being contacted directly and will be rescheduled at the earliest opportunity. Elective activity at other hospitals is unaffected by this decision.
In recent days, UHL has seen high volumes of patients attending, including many frail elderly patients requiring admission. In the 24-hour period up to 8am on September 15th, a total of 238 patients attended the Emergency Department (ED). The average number of daily attendances during 2019 was 195.
The group has appealed to the public to consider all other care options including attending minor injury clinics in Ennis and Nenagh.
It stated every effort is made to observe social distancing and keep wait times to a minimum.
INMO assistant director of nursing, Mary Fogarty said their members are extremely concerned about staffing in the hospital within the ED, overcrowding and lack of social distancing.
She estimated there are close to 100 nursing vacancies at UHL. To address the staffing needs of 122 extra beds that are coming on stream, she said another 250 nurses are required.
Acknowledging the group has advised the union it will be recruiting 150 nurses from an overseas country, she pointed out the union didn’t know when they would be arriving and how the new nurses would be integrated taking into account skill mix.
Claiming the situation in the entire hospital was “unsafe”, she stated the Acute Medical Assessment Unit is grossly overcrowded with no social distancing.
Of the 69 patients on trolleys on Tuesday, she stated that eight elderly patients were left on chairs because there was no room to put a trolley in the AMU.
“Some of frail elderly patients that were admitted were left on chairs overnight. They were using the bed table as a bed and were leaning forward on it. It is unacceptable that any admitted elderly patient is left on a chair.
Welcoming the curtailment of elective services, despite the difficulties it causes for other patients, she claimed the hospital is not safe in terms of its current activity and gross overcrowding.
She confirmed the union had written to HIQA to complain about overcrowding and lack of social distancing for patients and staff and HIQA have written back advising that there is little they can do, apart from the opening of additional bed capacity.
Last night, Ms Fogarty stated there were 146 patients in the ED with a deficit of six nurses on duty, which she described as “very serious”.
She said the union believes staffing is not in place now to cover additional bed capacity.
“Our members are contacting us hourly in relation to the situation at the hospital. It is extremely serious.
“We have concerns from an industrial relations point of view the hospital doesn’t comply with agreements when we reach them or it moves ahead to implement change without consultation with our members.
“Members are concerned that new beds will open without proper staff and the hospital will be left in an even worse situation than it is at present.
“There is a huge issue in the hospital in relation to the retention of staff. The environment in the hospital is not conducive to retaining nurses and other staff.
“The group have gone ahead and opened other facilities without agreement. The Intermediate Care Facility in UL took staff out of the hospital, they have expanded areas to stream patients because of Covid-19, which required additional staffing that are not in place.
“It is extremely unsafe. At 8.45 am on Wednesday morning I have emails from our members who spent the night working in the hospital,” she stated.
The nursing union are continuing to ballot members on the alleged failure of the group to engage in relation to additional bed capacity that needs to come on stream, filling of existing vacancies and overcrowding at the hospital.
Like other unions such as SIPTU, they expect to conclude their ballot at the end of this week concerning the need to alleviate pressures on the hospital.
A meeting of the Workplace Relations Commission advisory service was held between the union and the group recently.
Ms Fogarty said conciliation services are required to address key issues such as opening of additional beds and staff.
She claimed two weeks ago the national HSE has requested the hospital group to attend WRC conciliation and to date this hasn’t been confirmed.
“That is why we are balloting, we don’t have an option in terms of trying to engage with the hospital in terms of opening extra beds and filling vacancies.
“While the group are recruiting, we don’t know the number of nurses on panels waiting for a job and if they haven’t been taken on, why is this is happening.
“We believe they may be holding off on employing extra staff until the new beds are ready to open and they will be put in there rather than filling the current vacancies.
“We don’t want industrial action but it is the only option when you are dealing with an employer that will not engage or consult with staff. All of the trade unions have written to the WRC advisory service seeking support on a variety of issues,” she added.
Deputy Violet Anne-Wynne expressed concern the hospital can’t deal with standard ED admissions and elective procedures in the middle of battling a global pandemic.
“I am truly concerned by the news that the UHL group has cancelled all elective procedures in the hospital due to the over-crowding issues they are again facing.
“Figures of 69 patients on trolleys is not acceptable and we should no longer accept this as normal.
“There are way too many staffing vacancies within the hospital and these need to be addressed as a matter of urgency.
“How do the HSE and the Minister intend on dealing with what will be the “perfect storm” as we head into the Winter period for UHL?,” she asked.
At 8am on Tuesday morning, the group confirmed there were 48 admitted patients in the ED waiting for a bed, of whom 25 were waiting in single rooms or cubicles and 23 were waiting on a corridor.
All patients continue to receive expert medical care while they wait.
The group outlined the AMU has been operating as an ED for non-Covid-19 patients and when it becomes very busy and all beds and trolleys are occupied patients may be asked to wait on a chair but every effort is made to limit this as far as possible.
It stated measures are being taken to relieve pressure on the ED by the appropriate transfer of patients to community settings and maximising access to homecare packages and working with community intervention teams.
Prof Brian Lenehan, chief clinical director, said their immediate focus is on providing a safe environment for all patients, particularly in the context of the national public health emergency and ongoing increase in cases in the region and nationally.
The group stated current staffing deficits across the group stand at approximately 84 whole-time equivalent staff, or 4.8 % of their nursing workforce. This figure does not include temporary vacancies resulting from staff on maternity leave, sick leave etc.
“The group are actively recruiting with large scale banner advertisements prominent on campus. This recruitment campaign is on-going and we have been holding weekly interviews for staff nurses and midwives since early March 2020.
“The group are offering positions to successful candidates on a weekly basis. All current student nurses and midwives graduating from University of Limerick have been offered permanent contracts.
In addition we have also a further 150 nurses from overseas who will be starting on a phased basis from the beginning of November.
“As of the end of August 2020, we had recruited approximately 150 staff nurses in the year-to-date with an additional 16 staff returning from retirement or career breaks.
“The group is growing at a significant rate and the group is recruiting staff on a continuous basis to meet its current deficits and also support the staffing of its new developments.”
The group stated it is committed to consultation and engagement with trade unions on the much needed service developments and additional bed capacity under construction at UHL and at Croom Orthopaedic Hospital.
In the midst of this public health emergency, the group participated in a weekly teleconference with the IMNO and were happy to engage, facilitate information-sharing and ensure a meaningful discussion on issues of concern to the IMNO.